![]() ![]() ![]() The risk of bleeding with DOACs in patients with AF (rates per 100 patient-years) versus vitamin K antagonists were compared in separate studies. 6īleeding incidence and mortality in trials and observational data 5 Furthermore, DOACs are utilised in specific settings for prophylaxis during periods of particularly high risk, such as following orthopaedic surgery. Similarly, for suspected venous thromboembolism (VTE), DOACs are initiated while awaiting a confirmatory scan, in preference to low-molecular-weight heparin, in the absence of any contraindication, and are the agent of choice for a confirmed VTE, including in cancer patients. 4 A vitamin K antagonist is advised if a DOAC is contraindicated or not tolerated, and, for those established on warfarin, a transition to a DOAC should be offered. National Institute for Health and Care Excellence (NICE) guidance recommends DOACs (apixaban, edoxaban, rivaroxaban and dabigatran) for AF with a CHA 2DS 2-VASC score ≥2 and to consider anticoagulation with a score of 1. 1 - 3ĭOACs can be subclassified as inhibitors of clotting factor Xa (FXa) such as rivaroxaban, apixaban and edoxaban, and inhibitors of clotting factor IIa (FIIa) such as dabigatran etexilate. Direct oral anticoagulants (DOACs), also known as NOACs (non-vitamin K antagonist oral anticoagulants), have shown superior efficacy, safety, adherence and tolerability over traditional anticoagulants, such as vitamin K antagonists and low-molecular weight heparins, and this has resulted in a paradigm shift with DOACs as the preferred options for most patients with thrombotic disorders. atrial fibrillation (AF), valvular heart disease, congenital heart disease, and other indications. Anticoagulation is utilised in the management of venous thromboembolism and to prevent thrombotic complications in patients with cardiac comorbidities, e.g. ![]()
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